Should People Without Celiac Disease Avoid Gluten?

There has been a lot of hype around whether or not people without Celiac disease should avoid eating gluten or not. The headlines are blowing up my news feed with the message that Gluten sensitivity doesn’t exist and anyone who thinks they have it is delusional.

The posts are linked to a new study which found that a group of patients with irritable bowel syndrome (IBS) were not sensitive to gluten. In their new study of 37 subjects (aged 24-61 y, 6 men) the authors specifically isolated gluten and found there was no difference in symptoms between the patients eating high-gluten diets and those eating low-gluten diets.

Their claim that this proves that non-celiac gluten sensitivity doesn’t exist is a great way to generate clicks and attention at best and inaccurate, irresponsible and an extreme distortion of what was actually found at worst.

Participants were randomly assigned to groups given a 2-week diet of reduced FODMAPs, then randomly assigned to one of three groups: a high-gluten diet, a low-gluten diet, and a placebo. Those on the high gluten diet were given 16 grams per day of purified wheat gluten; those on the low gluten diet were given 2 grams per day of purified wheat gluten plus 14 grams per day of whey protein isolate; and those on the placebo diet were given 16 grams per day of whey protein isolate.

The results concluded that all participants, gastrointestinal symptoms consistently and significantly improved during reduced FODMAP intake, but significantly worsened to a similar degree when their diets included gluten or whey protein. There was no difference in symptoms between the high gluten, low gluten, or placebo groups during the subsequent treatment period.

This is suggesting that something other than gluten in wheat is causing the problems patients experienced. Another possibility is that both the placebo and low-gluten groups were reacting to the whey protein. This is certainly possible, if not highly likely, for people who already have digestive problems (ie. IBS). If some of the “placebo” and low-gluten patients were, in fact, sensitive to whey, then that would undermine the results of the study.

The study actually supports the idea that patients with IBS should avoid wheat because it contains FODMAPs and possibly other compounds that make them feel worse. We now know that there are several compounds in wheat other than gluten that could be to blame. These include not only FODMAPs, but also agglutinins (proteins that bind to sugar), prodynorphins (proteins involved with cellular communication), and additional proteins that are formed during the process of wheat digestion, such as deamidated gliadin and gliadorphins (aka gluteomorphins).(1)

For the first two weeks, going gluten free worked. If the FODMAP worked they’re still not eating wheat and they’re still experiencing relief from debilitating symptoms. This is the important part. Not everyone can wait around for a consensus from the literature before dealing with health issues. And going gluten-free does not hurt as long as you don’t just replace gluten grains with gluten-free junk food.

The best way is to figure out what is true for you.

Remove all gluten-containing foods and products from your diet for 45 days.

At the end of the 45 days, cook up and eat a bowl of barley and see how you feel.

A few days later, eat a piece of wheat bread.

Barley is a gluten-containing grain that is low in FODMAPs. If you react to it, that suggests you’re intolerant of gluten or other gluten-like compounds. If you don’t react to barley, but you do react to the wheat bread, that suggests you are intolerant to something in wheat specifically.